Are cohort data on smokeless tobacco use and pancreatic cancer confounded by alcohol use?

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Abstract
In the meta-analysis of pancreatic cancer case–control studies reported by Bertuccio et al. [1], the authors found no association between use of smokeless tobacco (ST) and risk of pancreatic cancer. This finding contradicts two large cohort studies from northern Europe [2, 3]. The authors speculate about possible differences in ST products but emphasise as the most likely explanation for the discrepancy that the case–control studies, as opposed to the cohort studies, adjusted for major confounding factors, including ethnicity, education, body mass index (BMI), diabetes and alcohol consumption. The results have prompted a proponent for ST to exclaim “ … almost significant for a PROTECTIVE EFFECT” and “ … directly addresses a persistent question about the integrity of previous studies” (http://rodutobaccotruth.blogspot.com/). Therefore, we feel obliged to comment on the authors’ interpretation.

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